Colonialism, cross-border movements, and epidemiology: a history of public health in the Manica region of central Mozambique and eastern Zimbabwe and the African response, 1890-1980

This dissertation addresses one of the reasons for the lack of confidence in public health in Southern Africa. It examines the impact of intrusive colonial public health measures and colonial attempts to suppress indigenous healing practices in the Manica region. The dissertation asks whether invasive colonial public health interventions had unintended consequences, such as the continued existence of traditional medicine and the reluctance to accept biomedical arguments on the epidemiology of infectious and communicable diseases. While these intrusive colonial public health measures were constant and pervasive, they were not always effective, partly due to the border that colonialism created. The epidemiology of the Manica region is fundamentally affected by cross-border movements, which not only spread infections, but altered disease ecologies, complicating disease control efforts. Colonial efforts to monitor movements led to the disruption of life and caused much hardship to villagers and townsfolk.

Reflecting the dynamism of African societies, this dissertation argues that while Africans tended to dislike intrusive and discriminatory preventative public health policies, they were willing to experiment with new ideas, particularly treatment services. They were discouraged, however, by the failure of colonial governments to provide adequate treatment-based services for Africans, proving that the provision of health services for Africans was driven by European settler fears of infection and economic imperatives rather than the concern for Africans. However, most of these settler fears stemmed from misunderstandings of epidemiology, and were often grossly exaggerated and racist. Regardless of whether these theories were accurate or not, they still caused hardship. Although this project looks at the history of public health before the HIV/AIDS pandemic in Southern Africa, the legacy of colonial public health policies affects how people in Southern Africa comprehend this disease. Through the use of archival materials and oral histories, this dissertation concludes that the current reluctance to embrace biomedicine is connected to social memory and perceptions of the state, and its legitimacy. Had resentment of colonial public health not played a role, biomedicine would have been more readily integrated as an additional option into a repertoire of alternative therapies in Southern Africa.